Breech & Bicornuate Uterus

An unusual uterine shape can occur during the development of the female embryo. An unicornate uterus happens when only half of the uterus develops. The shape is oblong, or tubular. A bicornuate uterus has two sections divided by a septum, or wall of tissue. The halves are smaller than the womb with a single “room.” Babies may grow too big to flip head down in the bicornuate uterus, even as early as mid-pregnancy. The uterus is heart-shaped.

It’s best to do the First Principle of Spinning Babies from as early in pregnancy as you can. Proactive women may begin bodywork or balancing exercises before pregnancy to improve the chance of a full-term, head-down baby. Be mindful of which exercises are safe in the first trimester.

Along with balancing activities for breech, drink 3-4 quarts of clear fluids a day, such as pure water, Red Raspberry Leaf tea, Chamomile tea, or Hibiscus tea. Milk is considered a solid as it turns to cheese in your stomach. Do as much as you can arrange for the next 10 weeks. Pay attention to maternal positioning, Rest Smart, etc. The most important time for fetal positioning is in the second trimester, not the third.

The bicornuate uterus adds a dimension beyond the straight forward descriptions upon which Belly Mapping depends. An ultrasound may be warranted.

An Aware Practitioner and some chiropractors/osteopaths may know these and other things that would help.

For a uniquely shaped uterus, the best time for helping fetal position is before 30 weeks. However, every unique uterus is …well, unique.

Cesarean Birth with a Unique Uterus

A common question parents face is when to schedule a cesarean for a breech baby. An unusual uterine shape is less likely to keep pregnancy going past the due date compared to a fully developed uterus.

Dr. Michel Odent has a great idea about the importance of fetal catecholamine levels rising in labor. He asks that women who need cesarean births not schedule their cesareans before labor begins on its own, unless there are very clear indications – like a breech or transverse position, for instance.

A healthy mom can go to the hospital when labor begins and have a surgical birth if needed. Having a cesarean after labor begin on its own can help assure that the birth hormones are heightened. Birth hormones, such as the stress hormone catecholamine, protect the baby somewhat from respiratory problems related to the lack of labor hormones at the time of birth by surgery. Also, waiting until labor protects the baby from a possibility of an early birth (late prematurity) which is related to a higher infant mortality rate in the first year.

So even if you schedule, waiting until a few days after your due date is more protective than scheduling before your due date. You may have to negotiate with your doctor about such a personalized plan.The challenge will be in having the OR and staff available when you begin labor. If you live in a rural area this will be challenging compared to living near a city hospital where they have 24-hour, in-house staff able to conduct a cesarean before you give birth to a breech baby.

Vaginal Birth with a Unique Uterus

Vaginal breech birth with your local doctors may also be an option. Having a unique uterus is not a reason not to try for a natural, physiologically-supported vaginal breech birth. If the baby can make the lateral flexion into the pelvis, the baby has a good chance of being born well vaginally. If the baby doesn’t have room to drop into the pelvis, contractions will have offered advantages of preparing the baby’s lungs for birth, reducing the chance of one of the complications of cesarean birth — poor fluid absorption from the lungs after birth. Labor, not “squeezing,” facilitates good absorption of fetal lung fluids. All the safety observations for breech birth apply, of course. And all the expectations for good outcomes when “hands-off the breech” and knee-chest maternal positions are observed.

Unicornuate uteri often result in breech and preterm labor as you have noted. I am not aware that there is an increased risk of rupture in your case. Some women deliver vaginally with this problem and sometimes the labor is dysfunctional due to the shape of the uterus or associated malformations of the cervix and end up with a C-Section. If your doctor is supportive of VBAC and your baby cooperates with size and position, then you may give it a go. And you are right, there is not much literature other than anecdotal cases, so common sense and nature must prevail.

In Ina May Gaskin’s first birth book, Spiritual Midwifery, there is a description in the back section of a woman with a bicornuate uterus and a story of how her various births went. You may appreciate the stories.

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